Diagnosis: Alcohol abuse.
Treatment: Inpatient Hospital Admission.

The insurer denied the Inpatient Hospital Admission. The denial is upheld.

This adult male patient with a history of alcohol abuse presented with alcohol withdrawal. He complained of anxiety, tremors, and poor appetite. The patient's vital signs were stable; heart rate was 81 and blood pressure was 135/89. The patient's exam was remarkable for tremors. There were no clinical signs of delirium tremens (DTs). His complete blood count and comprehensive metabolic panel were within normal limits. His chest x-ray showed no acute disease. The patient's electrocardiogram (EKG) showed normal sinus rhythm and no ST changes. His Clinical Institute Withdrawal Assessment for Alcohol (CIWA) score was three. The patient was admitted. The plan of care included Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol. On the next day, the patient's vital signs were stable. No benzodiazepines were required. The patient was cleared for discharge.

The proposed treatment was not medically necessary.

This patient with a history of alcohol abuse was admitted after presenting with alcohol withdrawal. He was not acutely intoxicated. The patient was hemodynamically stable and afebrile. He did not have tachycardia or arrhythmia. He had a mild tremor but did not have delirium tremens (DTs). The patient did not have vomiting. His labs were unremarkable. His Clinical Institute Withdrawal Assessment for Alcohol score was three. The patient was admitted with a plan for Clinical Institute Withdrawal Assessment for Alcohol protocol. He remained medically stable without signs of severe alcohol withdrawal. He did not require benzodiazepines. He had not failed a lesser level of care. The patient did not have symptoms that required an acute inpatient level of care and had not failed a lesser level of care. The acute inpatient level of care was not medically necessary.